Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) affect a significant and increasing number of U.S. families and, consequently, school systems. This article should be viewed only as a primer on these disorders but includes links for further reading.
What Is ADHD?
ADHD is a complex neuropsychiatric disorder of the brain. Children with ADHD may experience a variety of symptoms including those listed below. They may also be exceedingly disruptive in both home and school environments. In fact, in order to make the diagnosis, a child must have significant ADHD symptoms present in at least two settings (typically home and school).
Select ADHD Symptoms
- Constantly "on the go"
- Difficulty with sustained focus
- Difficulty staying seated
- Talks excessively
- Blurts out answers
- ADHD rates rose steadily from the early 2000s until 2011.
- The CDC provides a map of ADHD rates by state.
- ADHD rates stabilized at just over 10 percent by 2014.
- Boys are 2-3 times more likely than girls to be diagnosed with ADHD.
- The American Academy of Child and Adolescent Psychiatry (AACAP) reports the rate of ADHD is closer to 3-5 percent, demonstrating significant disagreement among professional organizations about ADHD rates.
How Is ADHD Diagnosed?
Ideally, diagnosing ADHD involves a multimodal approach that includes interviews with parents or caregivers, direct evaluation of the child, and extensive input from the child's teacher(s). In some instances, testing with objective instruments such as the FDA-cleared Quotient or NEBA ADHD tests may be useful to determine whether a child's lack of focus is due to ADHD or another underlying medical or psychological problem.
Although there are a number of useful parent and teacher ADHD questionnaires available, there is simply no substitute for a narrative from a child's teacher, either in writing or via teleconference.
What Is ASD?
ASD, like ADHD, is a complex neuropsychiatric disorder of the brain. ASD symptoms vary widely from person to person. However, a central theme is that people with ASD have significant problems relating socially. This may include having trouble interpreting other people's emotions, trouble expressing their own emotions, and making or maintaining eye contact. Emotional outbursts are common and range from mild to severe.
Other ASD symptoms may include delays in language and other aspects of development. Some exhibit stereotypical movements such as hand flapping, rocking back and forth, or pacing. Children with ASD may use toys or educational instruments in unusual ways or have difficulty understanding how to use them. They frequently have exceedingly narrow areas of interest, such as obsession with a book or movie series.
Raymond, played by Dustin Hoffman in the movie Rain Man, had an incredible memory and aptitude for math. Despite being a savant in the movie, Mr. Hoffman effectively portrayed some of the more common features of people with ASD. However, only about 1 percent of persons with ASD are savants.
How Is ASD Diagnosed?
There is no single, formal way to diagnose ASD. While there are a number of ASD diagnostic screening toolkits, most rely on parent or caregiver reporting in combination with direct clinician observation in the office. Some centers offer a team-based approach that may consist of a child/adolescent psychiatrist, child psychologist, speech and language pathologist, and other trained professionals.
What Are Some Treatment Options for ADHD and ASD?
Optimal treatment of ADHD and ASD involves a team approach. This ADHD treatment diagram describes one view of a holistic approach to treating ADHD, although such interventions could also be applied to ASD.
Medication is not the right choice for every child with ADHD. Having said this, ADHD medication has been shown to be very helpful in improving many children's ability to focus and concentrate when properly selected and appropriately dosed.
Applied behavioral analysis (ABA) therapy is considered by many experts to be the treatment of choice for ASD. Although there are FDA-approved medications for behavioral disturbances associated with ASD, such medications have not been shown to improve long-term outcomes of children with ASD.
School-Based Interventions for ADHD and ASD
- Whole-class interventions (whenever possible) to avoid singling out one child
- Behavioral modification tactics
- Regular backpack cleanouts
- Weekly summaries for caregivers
- Clearly posted classroom rules
- Immediate feedback, positive or otherwise
- Monitoring child for attention difficulties or frustration with a particular assignment
- Regularly scheduled physical activity (PDF) throughout the day
- Token economy (positive reinforcement system)
- 504 Plan or IEP
- Inconspicuous administration of any in-school medication
- Regular meetings with parents/caregivers
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Teachers Are Vital for Kids With ASD and ADHD
Teachers should not underestimate their importance as members of a multidisciplinary team in helping children affected by ASD or ADHD. Communication of what a teacher sees in the classroom to parents/caregivers and mental health professionals is extremely valuable. In addition, ASD and ADHD are diagnoses for which classroom intervention can make an enormous difference in affected kids' lives.